POS0485 FATIGUE USING PATIENT-REPORTED OUTCOMES MEASUREMENT INFORMATION SYSTEM (PROMIS) AND ITS RELATIONSHIP WITH DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS: A PROSPECTIVE STUDY FROM INDIA
Authors: A. Kumar P H, P.S. Kumar, R. Sivaprasad, N. K, K. Shukla, M. K. Garg, M. Gopalakrishnan
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Fatigue in rheumatoid arthritis (RA) is common, overwhelming and plays a key role in patients' perception of the disease and strongly influences global assessment [1]. While fatigue in RA has no internationally accepted definition, it is multidimensional and has an inconsistent association with disease activity in different populations with very few studies from India [2, 3]. <h3>Objectives</h3> To determine the relationship between fatigue as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue raw score with disease activity in patients with RA. To determine the predictors of fatigue in patients with RA. <h3>Methods</h3> A longitudinal study was conducted from January 2021 to December 2022 after Ethics Committee approval in patients with RA enrolled at our rheumatology clinic providing care to &gt;450 patients with RA, in a tertiary care hospital. Fatigue (PROMIS Fatigue-short form 7a), patient assessment of global disease activity (PtGA), Disease Activity Score (DAS28), and Clinical Disease Activity Index (CDAI) were measured. Serum samples for interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were collected and stored at -80<sup>0</sup> C. Relationship of fatigue was examined with age, hemoglobin, serum vitamin D3, TNF-α, and IL-6 using Spearman correlation coefficient. A Receiver Operating Characteristic (ROC) curve was constructed to determine the optimal PROMIS cut-off for defining PtGA &gt;2. Binary logistic regression analysis was used to assess predictors fatigue. <h3>Results</h3> One hundred and fifty-four patients were enrolled, of whom 133 (86.3%) were females, 103 were reassessed at 6 months (85.4% females). All were on conventional disease-modifying antirheumatic drugs. Patients in remission using DAS28 were 9.7% (n = 15) and 52.4% (n = 54) and remission/low disease activity (LDA) based on CDAI &lt;10 were 13.6% (n = 21) and 68.9% (n = 71) at enrolment and 6 months respectively. There was a significant reduction in median PROMIS at 6 months from 19(11) to 16(7) (p&lt;0.0001). PROMIS was significantly lower in those with remission/LDA based on CDAI (p&lt;0.0001) and DAS28 remission at enrolment and 6 months (p = 0.012 and 0.015 respectively). PROMIS &gt;11 had 93.8% sensitivity and 78.6% specificity to predict PtGA &gt;2 (AUC 0.92, 95% CI 0.81 - 1.00, P &lt;0.0001) (Figure 1). PROMIS &gt;11 was present in 89% at enrolment and 82.5% at 6 months. Age, hemoglobin, serum vitamin D3, TNF-α, and IL-6 had no correlation with fatigue. DAS28, CDAI, sleep (Pittsburgh Sleep Quality Index - PSQI), and depression (Patient Health Questionnaire - PHQ-9) were significant predictors of PROMIS &gt;11 (Table 1). <h3>Conclusion</h3> Fatigue is a significant problem in RA. A PROMIS score of 11 may be an acceptable cut-off for our population. Though fatigue improved with the treat-to-target approach, further studies are needed to determine if it is meaningful for patients. Along with disease activity, addressing sleep and depression is important in managing fatigue. <h3>References</h3> [1]Beaumont JL, Davis ES, Curtis JR, Cella D, Yun H. Meaningful Change Thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue and Pain Interference Scores in Patients With Rheumatoid Arthritis. J Rheumatol. 2021 Aug 1;48(8):1239–42. [2]Singh H, Arya S, Talapatra P, Lather K, Mathur R, Singhania A, et al. Assessment of fatigue in rheumatoid arthritis (by Functional Assessment of Chronic Illness Therapy-Fatigue score) and its relation to disease activity and anemia. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis. 2014 Mar;20(2):87–90. [3]Versteeg GA, ten Klooster PM, van de Laar MAFJ. Fatigue is associated with disease activity in some, but not all, patients living with rheumatoid arthritis: disentangling "between-person" and "within-person" associations. BMC Rheumatol. 2022 Jan 7;6:3. <h3>Disclosure of Interests</h3> None Declared.